Human Services Placement Application

Last Name

First Name

CNM ID Number

Phone Number

CNM Email Address FERPA guidelines indicate that electronic communication can only be sent via student’s @cnm.edu account. You must check this account regularly. Please contact the CNM ITS Service Desk at (505) 224-4357 if you are unable to access your CNM e-mail or if you are experiencing other technical difficulties.

What term are you applying for placement?

Course Instructor Select the last name of the faculty assigned to the HSV 2890 class for which you are enrolled.

Can you pass a background check? Many organizations require you to pass a background check to complete complete practicum hours at their site. In order to find an appropriate placement for you, please indicate if you can pass a background check or not.

Yes
No

Do you have a current resume? Most placements require a resume and introduction letter. Please send a current resume to fieldexp@cnm.edu. Your instructor for the course may also request a copy.

Yes
No

Days and Times Available to Complete Hours Enter the schedule of days and times you will be available to complete field experience hours. **Keep in mind, if you limit your availability, placements options will be limited. Example: Mondays 12:00pm - 5:00pm/Thursdays 8:00am-3:30pm

Type of Setting Please consider the type of population you hope to work with throughout your field experience and provide at least 3 suggestions below. You can provide specific agency names and/or general options. Example: Domestic Violence, Homelessness, Alcohol and Substance Abuse.

Type of Setting (continued) Please provide any information about settings you would not be comfortable being placed in for field experience.

Age Group Please select all age groups you are willing to work with.

Birth -5

Elementary

High School

Adults

Area of Town Select all areas of town you would prefer to be placed. These options cannot always be guaranteed but will be taken into consideration.

ABQ - Northeast

ABQ - Northwest

ABQ - Southeast

ABQ - Southwest

Rio Rancho

If yes, please indicate where and your title.

Comments Please provide any additional information you feel is important regarding your placement.

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